PRN range analgesia.

Published

There is one article from the journal - Pain Management Nursing.

Nurses’ opinions on appropriate administration of prn range opioid analgesic orders for acute pain.

Nurses' Opinions on Appropriate Administration of PRN Range Opioid Analgesic Orders for Acute Pain

At page 135, one example of prn range analgesic administration is as follows:

A range order reads morphine 2 to 8 mg IV every 2 h PRN. The patient receives the following doses: 2 mg
at 12:00 (no relief); 3 mg at 13:30 (no relief); 6 mg at 14:00.

A next dose can be given as early as what time?

The appropriate or preferred response is 15:30 or 16:00

As 6 mg was given at 14:00, according to q2h, the preferred administration time would be 16:00.

What is the rationale of also considering 15:30 as appropriate or preferred? Obviously only 1.5 hours passed. Certainly, the 6 mg given at 14:00 is not a maximum dose.

Can anyone please explain the rationale?

1
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At1200hrs pt recieved 2mg, at 1330hrs pt recieved 3mg and at 1400hrs pt recieved 6mg. The next appropriate time that the pt can recieve another dose is 1600hrs.

The order is 2-8mg every 2 hours. This means that 8mg is the maximum dose within 2 hours. The pt has recieved 11mg within 2 hours.

At 1400hrs the pt should have only had 3mg

If a pt is requiring more analgesia then ordered to control pain then they need reviewing. Does this make sense.

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14 hours ago, AussieRN12 said:

At1200hrs pt recieved 2mg, at 1330hrs pt recieved 3mg and at 1400hrs pt recieved 6mg. The next appropriate time that the pt can recieve another dose is 1600hrs.

The order is 2-8mg every 2 hours. This means that 8mg is the maximum dose within 2 hours. The pt has recieved 11mg within 2 hours.

At 1400hrs the pt should have only had 3mg

If a pt is requiring more analgesia then ordered to control pain then they need reviewing. Does this make sense.

Thanks for your good participation.

Perhaps your demonstrated wrong understanding about the example from the journal - Pain Management Nursing.

One reply from you is ''The order is 2-8mg every 2 hours. This means that 8mg is the maximum dose within 2 hours. The pt has recieved 11mg within 2 hours. "

Actually, this patient didn't receive 11 mg within 2 hours.

At 1200 hrs pt received 2 mg. No pain relief.

At 1330 hrs pt received 3 mg, which means 50% dose increment. No pain relief.

At 1400 hrs pt received 6 mg, which means 100% dose increment.

This kind of dose adjustment is a common practice in pain management regarding PRN range analgesia, although the percent of dose adjustment would be different under different circumstances.

The interval of the first two hours means from 1200 hrs to 1359 hrs. In the first two hours, this patient only received 2 mg + 3 mg = 5 mg, which is not 11 mg. Obviously 5 mg is less than the maximum 8 mg.

Another reply from you is: "At 1400hrs the pt should have only had 3mg".

The previous 2 mg and even 3 mg are not effective to relieve pain, in other words, 3 mg is not considered as an effective dose. It is not supposed to repeat an ineffective dose.

It is a good practice to give 6 mg at 1400 hrs, according to the example from the journal - Pain Management Nursing.

Further discussion is welcome.

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The link is not working can you please fix it so I can read the material

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You can copy the weblink and paste it into the URL address field of a web browser. Then press the "Enter" key on the keyboard of a computer.

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Yes I tried that and it told me that the website can not be found

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Crew, D. J., Gordon, D. B., Morgan, B., & Manworren, C. B. (2018). “As needed” range orders for opioid analgesics in the management of pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Pain Management Nursing, 19, 207-210. https://doi.org/10.1016/j.pmn.2018.03.003

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